Maximizing your advanced practice workforce through implementation of CMS’ 2023 MPFS split/shared rule

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* 1. True or False: In the new split/shared rule of 2022, CMS defines “substantive” documentation as completion of all required components for the history, physical exam, or medical decision-making based on the level of service billed.

True

False

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* 2. True or False: When the split/shared rule takes full effect, current workflows used by most APP/physician teams would not likely cause a change in billing volume for either the APP or the physician.

True

False

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* 3. True or False: There is no need to include a modifier when filing billing claims under the new rule.

True

False

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* 4. When the split/shared rule is fully implemented, the only provider who can bill for service is the one who:

Documents substantively

Provides more than 50% of the care

Both A and B

None of the above

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* 5. True or False: Although APPs are often paid at a lower rate than physicians, MGMA data from 2020 suggests practices may still see a financial upside in having a higher APP-to-physician ratio.

True

False

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* 6. Medical groups who are ready to face the challenge of new split/shared billing rules should focus on all but which of the following areas of interest:

Cultural preparedness

Number of APPs per physician

Payer enrollment

Education